Provider Demographics
NPI:1053737957
Name:CONRAD, JULIE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 W MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1942
Mailing Address - Country:US
Mailing Address - Phone:773-304-7789
Mailing Address - Fax:
Practice Address - Street 1:1436 W RANDOLPH ST
Practice Address - Street 2:204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1405
Practice Address - Country:US
Practice Address - Phone:312-733-0883
Practice Address - Fax:888-733-1772
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010486225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist